Insomnia query?

[GaryHB]

Good morning. I am grateful for this group. I came off Tramadol about 2 weeks ago - a bit too fast - as I was developing tolerance to it. I switched to Red Vein Kratom which a member of this forum suggested to me and which I had not heard of before. The Kratom works really well - but I am struggling with bad insomnia on and off. Some nights I am awake from 11pm to 4am - its exhausting. Does anyone know if Kratom can cause insomnia or if this is likely to be Tramadol withdrawals? If it is Tramadol withdrawals, how long do they go on for? Any advice from someone experienced in this would be welcome! Thanks in advance.

[Hidden]

same problem with buprenorphine/temgesic. opioids (kratom ("opiod-like") is believed to act on opioid receptors) are known to disrupt sleep architecture and sleep stage distribution. however, benzodiazepines, z-drugs, + even gabapentinoids etc,. are not appropriate to solve this problem (possible respiratory depression in combination with opioids). personally, i will ask my doctor whether an orexin antagonist ( daridorexant) can be used. i doubt that ;-( .

in addition, in your case, tramadol is also a serotonin-noradrenaline -reuptake-inhibitor.

+ kratom: pubmed.ncbi.nlm.nih.gov/295...

[GaryHB in reply to Hidden]

Ok thats helpful thanks. I had bad insomnia for the 6 months I was on Tramadol and it would seem Kratom can do the same?? From what you are saying, only meds for insomnia may help? It does seem that some people sleep 'like a log' on red Kratom? Some in this forum say they sleep for 6 hours straight? So confusing. Could it be down to everyone's personal makeup? I am desperately trying to make Kratom work because if it doesn't I am stumped as to where to go next. Thanks again for your reply.

[Hidden in reply to GaryHB]

yep, kratom can do the same. unfortunately there is conflicting data regarding kratom. it has not been researched enough, studies are rare. many people have positive things to say about kratom. however, this should be enjoyed with caution.

mayoclinic.org/healthy-life...

meds for insomnia like benzodiazepines or z-drugs may help, but should not be used in combination with opioids (and kratom is "opiod-like" - 2 compounds are partial agonists of the μ-opioid receptor - for example) . this also applies to gabapentinoids.

fda.gov/drugs/drug-safety-a...

the only meds for insomnia that i know of, which do not pose the risk of repository problems in combination with various other medications, are orexin antagonists. however, there are small studies which suggest that orexin antagonists can trigger rls/wed. so probably only the usual "natural medicines" remain (except for melatonin, which also strengthens rls/wed).

[GaryHB in reply to Hidden]

Oh my word it is so confusing.... such a trial. Thank you for your detailed response. It seems all meds have 'threats'. I was on pramipexole for 20 years - changing very few months to a week of Codeine when tolerance to the Prami occurred. But I hated the Prami - it made me agitated and at night my whole body was so tense in bed. I slept because it knocked me out but I had frequent 'dark days' when my mood was very low. I found opiates/Kratom much more effective in relaxing my body and reducing the rls and agitation.

[SueJohnson]

I have no experience with either but researching it, either could cause insomnia and the usual timeline for the withdrawal symptoms to go away is 3 to 5 days although it is variable, so you could wait and see if your insomnia goes away after that. Also it says kratom at low doses is a stimulant but at high doses is a sedative. Safe OTC options for insomnia include: valerian, chamomile, hops, L-tryptophan, 5-HTP, glycine, and GABA. Some prescription medicines include Ativan and Ambien.

[Hidden in reply to SueJohnson]

regarding gaba: it is still debatable whether gaba supplements are a waste of money or not, because it is still debatable, if gaba can cross the blood-brain - or not. at least i didn't feel any improvement/effect. regarding ativan: lorazepam is a benzediazepine, therefore caution is advisable in combination with kratom.

[SueJohnson in reply to Hidden]

Ambien is not a benzodiazepine so you might want to go with that.

[Hidden in reply to SueJohnson]

almost forgotten. ambien/zolpidem is a z-drug. therefore the same applies to zolpidem as to lorazepam. unfortunately ;-( . when i was still taking DA's (horrible) , i could combine with zolpidem. in my case: paradoxical reaction. same with zopiclon. now, with buprenorphine, the alternatives are running out. one DORA (daridorexant) is available in my country. i will to ask my doc whether the insurance company will take care of that, but that will be pointless anyway, since, as written, it is now assumed that DORA's can trigger/intensify rls/wed. however, the data for this are still scarce. ps: thank you for all your contributions in this forum - you help tirelessly.

[GaryHB in reply to SueJohnson]

Thank you for your tireless efforts Sue - as others have said. So if I have been off Tramadol for 15 days, the withdrawals should have stopped? I was taking Tramadol 3 times during the day. I now experience racing heart, agitation, nausea and exhaustion at those times I used to take Tramadol which is why I thought it was withdrawals. Only by taking Kratom at those times does it go away. I try and take only 1/2 to 1 teaspoon at a time. But it seems all I have done is change from 1 opiate to 'another'?

[TeddiJ]

Hi-I am the person who told you about kratom. I do think withdrawals can last a lot longer than people know-our bodies and brains need a lot of time to adjust. I also want to tell you that I do get antsy and have withdrawals if I go too long without kratom. I am able to take breaks from it with hirsuta and suboxone, as I have replied to you elsewhere. I may try to switch to hirsuta, which isn’t addictive, they say. I know-there is no great answer if you don't want to go on an opioid full time.

[GaryHB in reply to TeddiJ]

Sorry just seen this. Thanks for your reply. I'm now 30 days on Kratom. I think it's the most effective med I've ever taken for stopping rls. It really works well. But I'm still not sleeping well and I have days of terrible exhaustion and very low depressed feelings. I dont know what is causing this? I don't know if its still Tramadol withdrawals or damaged brain cells from 2 decades of pramipexole use.... which some people have suggested. I'm currently taking Kratom at least 3 times a day to try and lift my mood.

[TeddiJ in reply to GaryHB]

I wonder if too much kratom is causing your insomnia? So sorry you still aren’t sleeping. 

[GaryHB in reply to TeddiJ]

Thanks for your reply. I have read a few articles where they say, less is best so go for the lowest dose to get the desired effects. I am working on that and trying to use as little as possible. Last night I took 10g before bed, was hyper for about 1 hour and then slept soundly for 7 hours so that was an improvement. If I can get rid of day time doses, and only take it at night that would be a positive step in the right direction.

[Birdland]

I had to stop taking kratom because it caused me horrible insomnia.

[GaryHB in reply to Birdland]

Ah ok.... what a trial this all is!! Thanks for sharing your expereince.

[GuillaumeL]

I share a similar experience with Methadone. I'm only at a low dose (5mg) + 150mg Pregabalin. It works wonder to dampen my RLS. However sleep onset is difficult.

I was prescribed Zolpidem (Ambien) as a short term solution to try and reset my sleep cycle. It was very effective at making me sleep. But side effects the following day were bad (irritability, depression, difficulty to concentrate) and I couldn't sleep without it after only a few days of use. Every time I tried to stop, I had severe insomnia for 1-2 days. Then the milder opioid insomnia resumed.

Luckily, I have a sleep specialist who follows me. I just started Trazodone (50mg). It was previously used as an antidepressant simply because it made people calm and sleepy (oh boy...). It's now a sleep drug. It's not a Z class like Zolpidem. It's a serotonin antagonist and reuptake inhibitor (SARI) class.

I've been on it for a week. So far so good. It doesn't trigger RLS. I've managed to sleep 8 to 9 hours every night for 5 days straight. Side effects include dry mouth and being dizzy in the morning before eating and drinking my first coffee. You could ask your GP or sleep specialist to prescribe Trazodone, it's a fairly common drug used for insomnia. Depending on your age, there's the risk of falling if you try to go to the bathroom during the night.

Cheers and good luck,

[GaryHB in reply to GuillaumeL]

Thank you so much for your reply. That is so helpful. I was actually on Trazadone last year as a trial for anxiety and to see if it helped with RLS. As it didnt help with the RLS I came off it. I cant remember if it helped me sleep or not but I am so glad you mentioned it. I could definitely try that again. That sounds a better option than sleeping pills. Cheers and thanks for taking the time to reply. All the best.

[Shumbah]

This is my natural bedtime formula

Top shelf vitamin brands are important

I use mostly use the brand THORNE

Thorne have some really interesting vitamin formulations

magnesium forte x2

Potassium x1

GABA 1 to 2 or you can take one at bedtime and another if ou wake during the night , no more or it has the opposite effect.

Ashwagandha 200 mg 1 or 2

I take the above with a glass of milk

CBD oil use sublingual

If you wish you could add B Complex and folate

My son use lavender capsules he finds them good .

Avoid artificial sugar and real sugar in the evenings.

Professor Winkelman suggests taking Buprenorphine earlier in the day for those who suffer insomnia and to add some type of sleep aids

You are right we are all different that is what makes it hard.

I have found the above Tried and tested.

Quality is very important a lot of vitamins we only absorb 2 percent

[GaryHB in reply to Shumbah]

Thanks for taking the time to reply. I appreciate it. I will take a not of all those supplements and give them a go. I also read about your positive experience with Buprenorphine and how it helped you sleep. Thanks again.

[Shumbah in reply to GaryHB]

Wish you well

[GaryHB in reply to Shumbah]

I have a question about Buprenorphine... did you ever develop tolerance to it and needed to come off it? I developed augmentation with Pramipexole and have developed tolerance on Tramadol and now likely Kratom too. I am wondering if this happens too with Buprenorphine which I ahve not tried?

[Shumbah in reply to GaryHB]

Sorry I tried to respond whilst travelling ,was not sufficient wifi

No tolerance buprenorphine /subutex is a very superior drug and really cannot be compared to other opioids.

The evidence shows no creep on dose.

I was meant to take 2 mg Subutex however I only took1mg

1 year on I went back to exercising and that required me to add a little more.

I have never needed to increase my dose above prescribed dose of 2mg

Over 3 years now sleep like a baby

[GaryHB in reply to Shumbah]

That is so encouraging! Thank you for getting back to me. Much appreciated.

[SleeplessinOR]

I am currently alternating between Tramadol and Oxycodone. I get to tolerance pretty quickly so I switch back and forth and it seems to be working. However, I also suffer from insomnia. The only thing I’ve found that helps me are CBD/CBN gummies coupled with a very small piece of THC/CBD gummy. THC gives me a migraine so I’ve taken a THC/CBD gummy and cut it into 8 pieces. Just one of those little pieces coupled with 2 of the CBD/CBN gummies has given me better sleep than I’ve had in a very long time. If it’s legal where you are you might give it a try. Since it isn’t safe to take any type of sleep aid I tried these and they help me a great deal.

[GaryHB in reply to SleeplessinOR]

Thank you for your reply. Its not legal here. I have found increasing the Kratom has helped sleep. I hope you get a workable solution for your tolerance issues. Its tough! I face the same.

[Irmajs]

I don’t know if this will help you because you are in the UK. I am in the US and have found most medications either ineffective, causing augmentation or other bad side effects. I use CBD effectively to control my RLS and a small amount to THC to get me to sleep. I’m sorry for what you are going through. RLS can be maddening as well as finding a something that works. Good luck.

[GaryHB in reply to Irmajs]

Thank you for your reply - I am in the UK and cant get that. As you say - its so hard finding a solution. All the best to you.

[Doctorplacebo]

A couple comments on sleep meds which might be helpful, or not.

First, Sue, regarding z-drugs: Ambien (zolpidem) and zopiclone or eszopiclone (Lunesta). Although these have been termed "non-benzodiazepine sedative-hypnotics" because the molecule is not a benzodiazepine, they work in the brain exactly like benzodiazepines, i.e., they bind to GABA receptors. Therefore they have most of the same side effects including respiratory depression. They don't seem to be as addictive, though.

Sorry, I don't have my references for the above at my fingertips, but you can google this under "scholarly articles on non-benzodiazepine hypnotics" and see that it is so. (Once ChatGPT gets back online you can probably get even better information from it (him? her?)).

My personal experience with z-drugs is they only provided me with 2-3 hours of sleep, the sleep was of poor quality, and I didn't feel so good in my brain the next day. Plus I am prone to sleep apnea so, all in all, I avoid them except as a last resort.

I am currently taking hydroxyzine 25mg an hour before bedtime to combat the insomnia caused by my low dose methadone. Although it is an antihistamine, it is listed on the RLS Foundation's medical alert card for RLS as a safe alternative to diphenhydramine (Benadryl). It seems to work for me without increased RLS and gets me 6 or sometimes 7 hours of sleep (after 3 years of 4-5 hours), but I am on an opioid and I'm me. It could potentially exacerbate RLS in others.

Regarding kratom and somnolence: FWIW, my personal experience was that for about a year red vein kratom helped both my RLS and gently put me to sleep with a smile on my face, but then it lost its sleep-enhancing effect, for me and seemed to cause insomnia. Of course, effects are highly variable with different people, so only way to know is to try.

I wish you all a restful night's sleep!

[GaryHB in reply to Doctorplacebo]

I appreciate your reply.